CTICasesInfected Congenital Pulmonary Airway Malformation
[...]. Infected Congenital Pulmonary Airway Malformation. CTICases. Published September 11, 2026. https://cticases.com/c/y3zam
Imaging findings
A patient presented with chest pain and shortness of breath. CT showed a large central abnormality surrounding a bronchus and extending to the base of the right lung, shaggy and angry looking with some cavitation, raising concern for tumor as well as infection. A chest radiograph from several years earlier showed a normal right lung base, but an older CT showed a bubbly cystic lesion at that site. A PET scan a month after the acute presentation showed the right lung base quiet with no residual activity, and the limited CT component showed only a small fluid-filled focus medially.
Key takeaways
The most important study in this case was the old CT, which reframed an aggressive-looking consolidation as infection of a pre-existing congenital pulmonary airway malformation. A congenital cystic lesion can stay silent into adulthood and declare itself as a masslike inflammatory process that mimics malignancy. Distinct cystic components with normal lung interposed favor an infected CPAM over an empyema, which tends to look like a single empty shell. Complete resolution on follow-up imaging after treatment confirms the interpretation and avoids an unnecessary cancer workup.
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